What are the indications for using an Intrauterine Device (IUD)?

From the Guidelines

Intrauterine devices (IUDs) are a highly effective and recommended form of long-term contraception due to their high efficacy, low maintenance, and beneficial effects on menstrual bleeding and cramps, as supported by recent studies 1.

Reasons for Using IUDs

• IUDs provide reliable birth control for 3-10 years depending on the type, with failure rates less than 1%, making them more effective than pills, patches, or condoms.
• They require no daily attention or regular maintenance once inserted by a healthcare provider during a simple office procedure.
• Hormonal IUDs (like Mirena, Kyleena, Liletta, or Skyla) release small amounts of progestin locally in the uterus, which can reduce menstrual bleeding and cramps, and may eventually cause periods to stop altogether, as seen in studies such as 1.
• The non-hormonal copper IUD (ParaGard) provides hormone-free contraception for people who prefer to avoid hormones or cannot use them.
• IUDs are reversible, allowing fertility to return quickly after removal when pregnancy is desired.
• They're cost-effective over time compared to monthly contraceptive options.
• Additionally, IUDs don't interfere with sexual spontaneity and work by preventing fertilization primarily by inhibiting sperm movement and creating an environment unsuitable for pregnancy.

Benefits and Considerations

• Side effects may include cramping after insertion, irregular bleeding initially, and rarely, expulsion or perforation, but serious complications are uncommon, as noted in 1.
• IUDs are suitable for adolescents and are generally safe and effective methods of contraception with a failure rate of less than 1%, as supported by 1.
• HIV infection is not a contraindication to IUD use, and the use of an IUD in the context of HIV infection is classified according to CDC US medical eligibility criteria for contraceptive use as category 2, meaning that HIV is a condition for which the advantages of using the IUD generally outweigh theoretical or proven risks, as stated in 1.

Recommendations

• IUDs should be considered as a first-line option for individuals seeking long-term contraception due to their high efficacy, safety, and benefits, as supported by the most recent and highest quality study 1.

From the Research

Reasons for Using IUDs

• IUDs are a highly effective method of contraception with a failure rate of less than 1% 2, 3, 4
• They can be used by women of all ages, including adolescents and breastfeeding women 2, 3, 5
• IUDs have noncontraceptive benefits, such as treatment for heavy menstrual bleeding, dysmenorrhea, and endometrial hyperplasia/endometrial cancer 3, 5
• They are a safer alternative to sterilization for perimenopausal women seeking a long-term and reversible method of contraception 5
• IUDs can be used immediately after a pregnancy, in cases of diabetes or HIV infection, and during nonsteroidal antiinflammatory drug therapy 2
• Copper IUDs are a first-line contraceptive method for women with a history of deep venous thrombosis, pulmonary embolism, or coronary events 2
• IUDs do not protect against sexually transmitted diseases, and women must be warned about this risk 2

Effectiveness and Safety

• IUDs have similar contraceptive efficacy to combined oral contraceptives when used correctly, but are more effective than oral contraception used incorrectly 2
• The risk of pelvic infection is slightly higher in the first 3 months after IUD insertion, but routine antibiotic prophylaxis is unnecessary 2
• Uterine perforation during insertion is rare, occurring in 0.6 to 16 cases per 1000 insertions 2
• Expulsion of the IUD occurs in about 5% to 10% of cases within 5 years, and recurs in about 30% of these women 2
• IUDs can cause changes in menstrual bleeding, with copper IUDs often leading to heavier bleeding and levonorgestrel IUDs leading to a reduction in menstrual blood loss 2, 3

Continuation Rates

• One-year continuation rates for IUDs are high, with 60% to 70% of women still using their device at 12 months 6
• Continuation rates do not differ significantly between copper and levonorgestrel IUDs 6
• Providing IUD options for emergency contraception users presents an opportunity to increase availability of highly effective contraception 6